Bhattacharyya Parthasarathi, Ghosh Shuvam, Sen Srijita, Dey Debkanya, Sengupta Sayoni, Bej Saayon, Kar Avishek, Saha Dipanjan
Department of General Pulmonary Medicine, Institute of Pulmocare and Research, Kolkata, West Bengal, India.
Department of Obstructive Airway Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India.
Lung India. 2025 Jul 1;42(4):322-329. doi: 10.4103/lungindia.lungindia_54_25. Epub 2025 Jun 27.
The advent of glycopyrronium responsiveness has opened the prospect of selective responsiveness-based prescription of bronchodilators-β2-agonists or anti-muscarinic agents (AMA) for COPD. Such a concept needs ratification through clinical trials.
Stable COPD patients [post-bronchodilator FEV1/FVC <0.7] underwent serial glycopyrronium responsiveness [≥100 ml FEV1-improvement] after salbutamol before universal prescription of LABA-LAMA ± ICS as per guideline recommendation. At real-world follow-up, we noted the adverse and serious adverse events (exacerbations and hospitalizations) and, whenever possible, repeated spirometry in the similar fashion. Based on the initial glycopyrronium responsiveness, we divided the patients into glycopyrronium-sensitive and non-sensitive groups and compared the impact of treatment between them using spirometric variables (FEV1, FVC, FEV1/FVC and FEF25-75). We compared the 'trough'-FEV1 and 'total'-FEV1 (difference from the initial pre-bronchodilator to final post-dual-bronchodilator values) along with the frequency of exacerbation and hospitalization in each group.
The glycopyrronium-responsive and non-responsive groups (n = 30 for each) were similar demographically and on initial spirometry (pre-bronchodilator and post-salbutamol values). They received treatment for 162.4 ± 134.8 and 212 ± 118.1 days, respectively. The glycopyrronium-sensitive patients displayed significant improvement in both trough-FEV1 [0.17 ± 0.29 vs. 0.02 ± 0.2; (P = 0.0308)], total-FEV1 [0.32 ± 0.29 vs. 0.17 ± 0.21; (P = 0.0273) litres], in addition to trough FEF25-75 (P = 0.0204), total FEV1/FVC (0.0174) and total FEF25-75 (P = 0.0322). The exacerbations (P = 0.0056) were significantly lower in glycopyrronium-responsive patients.
The glycopyrronium-responsive COPD patients show a significantly better overall improvement including the significant change in trough and total FEV1 with significantly reduced exacerbations in the real-world observation. The revelation demands more research.
格隆溴铵反应性的出现为慢性阻塞性肺疾病（COPD）基于选择性反应性开具支气管扩张剂（β2 激动剂或抗毒蕈碱药物（AMA））带来了前景。这一概念需要通过临床试验来验证。
稳定期 COPD 患者[支气管扩张剂后 FEV1/FVC <0.7]在根据指南建议普遍开具长效β2 激动剂-长效抗胆碱能药物（LABA-LAMA）±吸入性糖皮质激素（ICS）之前，先接受沙丁胺醇治疗后进行系列格隆溴铵反应性测试[FEV1 改善≥100 ml]。在实际随访中，我们记录了不良事件和严重不良事件（急性加重和住院），并尽可能以类似方式重复进行肺功能检查。根据初始格隆溴铵反应性，我们将患者分为格隆溴铵敏感组和非敏感组，并使用肺功能变量（FEV1、FVC、FEV1/FVC 和 FEF25-75）比较两组间治疗效果。我们比较了每组的“谷值”-FEV1 和“总量”-FEV1（从初始支气管扩张剂前到最终双重支气管扩张剂后值的差异）以及急性加重和住院的频率。
格隆溴铵反应性组和无反应性组（每组 n = 30）在人口统计学和初始肺功能检查（支气管扩张剂前和沙丁胺醇后值）方面相似。他们分别接受治疗 162.4 ± 134.8 天和 212 ± 118.1 天。格隆溴铵敏感患者在谷值-FEV1[0.17 ± 0.29 对比 0.02 ± 0.2；（P = 0.0308）]、总量-FEV1[0.32 ± 0.29 对比 0.17 ± 0.21；（P = 0.0273）升]方面有显著改善，此外谷值 FEF25-75（P = 0.0204）、总量 FEV1/FVC（0.0174）和总量 FEF25-75（P = 0.0322）也有改善。格隆溴铵反应性患者的急性加重（P = 0.0056）显著更低。
在实际观察中，格隆溴铵反应性 COPD 患者总体改善明显更好，包括谷值和总量 FEV1 有显著变化，急性加重显著减少。这一发现需要更多研究。
